HomeMy WebLinkAbout4012 CAPSTONE CT - SPECIAL INSPECTIONS - 7/6/2021Community Development & Neighborhood Servic:es 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580 Phone: 970 221 6760 FAX: 970 224 6134 Fueld Verification Form ✓ Job Site t/o!2 /!.J;p,;,?(721/8 U, Company Name 11/orltel(I} fhio, &lo /Jl{l)1b1oc; .f ..,./Jrcua Permit No. .6~10 ;../:7-,7. 8 City of Ft Collins Lie# m/J, 5 7? __ Replacement of Sewer line _L Replacement of Watec.line approx.-,--__ ft. (100 ft. maximum) approx. lo 5 ft. (100 ft. maximum) __ Add __ Replace gas line approx. ___ ft. ( 50 ft. maximum) Materials used: 5 /4 I\ '(.-LOll?tl.2-tdC r, ~ws= Tested at \\J~::Ar~\\_e>f== . Lbs. for 2j -,11i11ote"~ prE~ Installer Name (print) i~~d.l/\--t1~ \\{:J 1 \~(-\,L~~ lnstallerSignature ~J ~~ Date '1-/C,/2. 2J